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World J Clin Cases. Dec 6, 2022; 10(34): 12484-12493
Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12484
Evaluation of gut dysbiosis using serum and fecal bile acid profiles
Tadakuni Monma, Junichi Iwamoto, Hajime Ueda, Makoto Tamamushi, Fumio Kakizaki, Naoki Konishi, Shoichiro Yara, Teruo Miyazaki, Takeshi Hirayama, Tadashi Ikegami, Akira Honda
Tadakuni Monma, Junichi Iwamoto, Makoto Tamamushi, Fumio Kakizaki, Naoki Konishi, Shoichiro Yara, Takeshi Hirayama, Tadashi Ikegami, Department of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, Inashiki-Gun 300-0395, Japan
Hajime Ueda, Teruo Miyazaki, Akira Honda, Joint Research Center, Tokyo Medical University Ibaraki Medical Center, Inashiki-Gun 300-0395, Japan
Author contributions: Iwamoto J, Ikegami T, Miyazaki T and Honda A designed the research; Monma T, Iwamoto J, and Honda A performed the research; Ueda H, Kakizaki F, Tamamushi M, Yara S, Konishi N, Hirayama T, Monma T, Iwamoto J and Honda A analyzed the data; Monma T, Honda A and Iwamoto J wrote the paper.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Junichi Iwamoto, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, 3-20-1, Amimachi-chuo, Inashiki-Gun 300-0395, Japan. iwamotoj@tokyo-med.ac.jp
Received: September 7, 2022
Peer-review started: September 7, 2022
First decision: October 20, 2022
Revised: October 25, 2022
Accepted: November 4, 2022
Article in press: November 4, 2022
Published online: December 6, 2022
Processing time: 86 Days and 7.7 Hours
Abstract

Dysbiosis in the intestinal microflora can affect the gut production of microbial metabolites, and toxic substances can disrupt the barrier function of the intestinal wall, leading to the development of various diseases. Decreased levels of Clostridium subcluster XIVa (XIVa) are associated with the intestinal dysbiosis found in inflammatory bowel disease (IBD) and Clostridium difficile infection (CDI). Since XIVa is a bacterial group responsible for the conversion of primary bile acids (BAs) to secondary BAs, the proportion of intestinal XIVa can be predicted by determining the ratio of deoxycholic acid (DCA)/[DCA + cholic acid (CA)] in feces orserum. For example, serum DCA/(DCA+CA) was significantly lower in IBD patients than in healthy controls, even in the remission period. These results suggest that a low proportion of intestinal XIVa in IBD patients might be a precondition for IBD onset but not a consequence of intestinal inflammation. Another report showed that a reduced serum DCA/(DCA + CA) ratio could predict susceptibility to CDI. Thus, the BA profile, particularly the ratio of secondary to primary BAs, can serve as a surrogate marker of the intestinal dysbiosis caused by decreased XIVa.

Keywords: Gut dysbiosis; Clostridium subcluster XIVa; Bile acids; HPLC-MS/MS; Inflammatory bowel diseases; Clostridium difficile infection

Core Tip: Gut dysbiosis, particularly decreased XIVa, correlates strongly with decreased conversion of primary BAs to secondary BAs. Decreased levels of Clostridium subcluster XIVa (XIVa) are associated with the intestinal dysbiosis found in inflammatory bowel disease (IBD) and Clostridium difficile infection (CDI). Since XIVa is a bacterial group responsible for the conversion of primary BAs to secondary BAs, the proportion of intestinal XIVa can be predicted by determining the ratio of deoxycholic acid (DCA)/ [DCA + cholic acid (CA)] in feces or serum. Therefore, the DCA/(DCA+CA) ratio in feces and serum is a valuable marker for detecting dysbiosis without genetic analysis of enterobacteria.